Perceived facilitators and barriers to clinical clearance of the cervical spine by emergency department nurses: A major step towards changing practice in the emergency department

Int Emerg Nurs. 2011 Jan;19(1):44-52. doi: 10.1016/j.ienj.2009.12.002.


Objectives: We conducted a validation study on use of the Canadian C-Spine Rule (CCR) by emergency department (ED) nurses to clear the c-spine in alert and stable trauma patients (N=3633). This survey sought to identify potential facilitators and barriers to an implementation policy that would allow nurses to clinically clear the c-spine of minor trauma patients.

Methods: We conducted a prospective quantitative survey of ED nurses in six hospitals. Questions were developed from a previous qualitative survey at the same validation study EDs.

Results: 158 ED nurses were surveyed and 137 (86.7%) responded. Nurses strongly endorsed potential facilitators for nursing clearance of the c-spine, including 'Like to try new things at work' (96.4%) and 'Easy for me to take on new responsibilities' (96.4%). Most respondents were comfortable applying the rule (89.1%). Nurses endorsed potential barriers but at much lower rates, with the most common being 'Heavy workload makes it difficult to use the rule' (37.2%). Variation existed among hospitals for the facilitator 'Use of the rule would be useful to my practice', ranging from 81.8% to 100% endorsement (P=0.004).

Conclusions: This survey was an important step towards the goal of empowering ED nurses to clinically clear the c-spine of alert and stable trauma patients. There was a high rate of endorsement of facilitators and a low rate of endorsement of barriers. We found variation between hospitals, emphasizing the importance of understanding local beliefs when seeking to change clinical practice. We are conducting an implementation trial based on this feedback.

MeSH terms

  • Algorithms
  • Attitude of Health Personnel
  • Cervical Vertebrae / injuries*
  • Decision Trees*
  • Diffusion of Innovation
  • Emergency Nursing / education
  • Emergency Nursing / organization & administration*
  • Emergency Service, Hospital / organization & administration
  • Female
  • Guideline Adherence / organization & administration
  • Humans
  • Male
  • Nurse's Role
  • Nursing Assessment / methods
  • Nursing Methodology Research
  • Nursing Staff, Hospital* / organization & administration
  • Nursing Staff, Hospital* / psychology
  • Ontario
  • Practice Guidelines as Topic / standards
  • Practice Patterns, Nurses' / organization & administration*
  • Professional Autonomy
  • Prospective Studies
  • Qualitative Research
  • Spinal Injuries / diagnosis*
  • Triage / methods
  • Validation Studies as Topic
  • Workload